"One-stop" settlement only requires the insured to provide valid ID cards and bank cards to the office staff of the Commercial Insurance Liaison Office; Sporadic reimbursement settlement needs to be handled at the special window of service outlets announced by insurance companies; Drug claims need to be handled through "Xihu Yilianbao" in the official account of WeChat.
In addition, if you want to claim, you need to know the purchase and claim terms of Xihu Yilian Office itself:
First, the insured object
Employees in Zhejiang and Hangzhou basic medical insurance for employees and basic medical insurance for urban and rural residents can participate in the insurance regardless of age, health status, past medical history and occupation category.
Second, the scope of reimbursable expenses.
"West Lake Benefit Joint Insurance" focuses on ensuring the expenses of serious illness medical care and high self-funded drugs, while caring for some patients with rare diseases and realizing the close connection with social medical insurance. Its main contents are as follows:
1. Supplementary medical insurance for critical illness insurance;
2. Supplementary medical insurance for reasonable drugs and materials outside the catalogue of hospitalization and outpatient medical insurance for specified diseases;
3. Innovative medicines and consumables medical insurance for specific tumors and critically ill patients;
4. Special drug medical insurance for three rare diseases, specifically Gaucher's disease, amyotrophic lateral sclerosis (frozen person) and phenylketonuria.
Third, the specific operation
1. System networking "one-stop" settlement
The medical expenses incurred by the eligible insured during the period from 202 11October1to 2021March 3 1 need not be applied separately, only the insured's (guardian of minors) valid ID card and valid bank card should be provided for reimbursement.
2. Sporadic reimbursement settlement
For the medical expenses incurred by the insured that do not meet the "one-stop" settlement situation of credit card and meet the conditions of claim settlement, sporadic reimbursement claims will be implemented. The insurer needs to go to the special window of the service outlets announced by the insurance company, and the urban areas need to communicate with each other. Tonglu, Jiande and Chun 'an need to go back to the local special window for handling.
3.28 Claims agreement and process for innovative drugs, consumables and three kinds of special drugs for rare diseases (the payment period will be implemented after March 3 1)
The operation of the reimbursement process is as follows: Pay attention to the official account of "West Lake Yilianban" WeChat, click Service Center > Claims Service > Innovative Medicine and Consumables Cost Guarantee in turn, and upload video claims data.
Relevant claim materials include:
1) Identity certificate of the insured.
(If the insured is a minor, the identity certificate and relationship certificate of the guardian shall be provided at the same time. )
2) Hospital medical records/discharge summary
(Hospitalization medical records include the first page of medical records, admission records, discharge summary, image examination report, etc. )
3) Pathological diagnosis report
4) Drug prescription
5) Immunohistochemical/genetic test report
6) The original invoice of the relevant drugs shall be collected by the insurance company. If it is not within the scope of insurance liability, the original invoice shall be returned.